Date of Graduation

Fall 12-15-2022

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


Kaiser cohort MSN capstone

First Advisor

Dr. Theresa Mostasisa


Background: Hospital Acquired Pneumonia (HAP) is a leading cause of most hospital-acquired infections among surgery patients who are hospitalized and bed-bound for more than 48hrs. The occurrence of HAP is associated with increased hospital stays and cost of care. However, its occurrence can be reduced by oral care. In this regard, this project aimed to decrease the incidence of HAP on the 3rd, 4th, 6th, and 7th floors on the Medical Surgical and ICU units of the Northern California Hospital.

Methods: To achieve the aim above, the project utilized methods namely SWOT analysis, Plan – Do – Study – Act (PDSA) cycle, and Cost-benefit analysis in the collection of data. The HAP Response recording tool was also used in the collection of data.

Results: Out of the 25 PCTs who took part in the study, 9 (36%) were familiar with the ROUTE Bundle was. The majority of the PCTs on the AM shift managed to implement oral care to patients under their care. Specifically, 7 of the PCTs who worked on AM shifts managed to perform oral care two times a shift and 18 of the PCTs were able to complete oral care once a shift. Over 21 PCTs (84%), identified staffing as a main barrier to their tasks and 76% felt that having the toothbrush on the tray would not be effective in increase oral care rates. There was also comments on issues with poor teamwork, no standardized oral protocol, lack of knowledge of oral care bundle, and a supply of poor oral care resources.

Conclusion: The implementation of ROUTE bundle reduces the incidence of HAP among patients who are bed-bound. Education and training of care providers on bundle is important, appropriate resources for oral care must be provided, there must be teamwork among nurses and PCTs, and a standardized oral care protocol must be implemented.

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